Health Care Access

Too few Houston-area residents are able to access affordable, high-quality health care consistently, contributing to poor health outcomes for a significant portion of our neighbors

Uninsured rates in the three-county Houston region have steadily increased since 2016, while physician availability and preventable hospital stays have improved.

The data

After six years of decline, uninsured rates in Houston’s three-county region have ticked up since 2016

When the Affordable Care Act was passed in 2010, its goal was to expand health insurance coverage by making it more affordable to more people. Many aspects of the program were implemented in 2014, including the establishment of health insurance marketplaces and the optional expansion of Medicaid eligibility.

Nationwide there were immediate gains in health insurance coverage, as the percentage of people without health insurance fell to 11.7% in 2014 from 14.5% in 2013. By 2019, the uninsured rate had declined to 9.2%, according to estimates from the U.S. Census Bureau.

Texas has had the highest percentage of residents without health insurance among all states in the U.S. each year for the last decade. In 2019, 18.4% of Texans didn’t have health insurance, double the U.S rate for that year. Not only is the uninsured rate in Texas nine points above the national rate, it is also four points above Oklahoma, the state with the second highest uninsured rate in the U.S.

Texas is one of 12 states that has not expanded Medicaid to cover additional low-income residents. Currently, legal residents of Texas can qualify for Medicaid if they are pregnant, responsible for a minor, have some kind of disability or a household member with a disability, or are older than 65 with low incomes. The income threshold for a household size of four is $59,400 before taxes. If Texas expanded access to low-income Medicaid beneficiaries, then residents with incomes up to 133% of poverty level could benefit. In 2019, an estimated 759,000 adult Texans were in what is known as “the coverage gap.” The coverage gap is experienced by people with incomes below the poverty level who are not eligible for financial assistance in the ACA marketplace.

The percentage of residents without health insurance in Houston’s three-county region has declined since the implementation of the Affordable Care Act in 2014. However, it remains well above the national average, and in recent years, has begun to increase again. Residents in Fort Bend County have historically had the lowest uninsured rates in the region, though figures have ticked up since 2016 and in 2019 matched Montgomery County at nearly 14%. In 2019, 22% of the Harris County population was uninsured, the highest uninsured rate in the region. 

Uninsured rates in 2019 in both Fort Bend and Harris counties were slightly above their 2014 level, when the ACA was implemented. These coverage losses likely stemmed from policy changes in 2017 that contributed to reduced access to and enrollment in coverage. Among these changes were decreased funds for outreach and enrollment assistance, and changes to immigration policy that made some immigrant families more reluctant to participate in Medicaid and the Children’s Health Insurance Program (CHIP), according to research by the Kaiser Family Foundation.³

COVID-19 Impact

How did health insurance coverage change during COVID in Houston? In an attempt to capture real-time effects of the COVID-19 pandemic, the Census Bureau began its Household Pulse Survey in April 2020. One of the questions asked about health insurance coverage. People in the Houston Metropolitan Statistical Area and in Texas were more likely to report lacking health insurance than that for the nation overall, by about 10 percentage points each survey period.

The majority of the area’s residents are enrolled in private health insurance (60%), mostly through employer-based health insurance. Slightly more than one in four have public health coverage such as Medicare and Medicaid. This has remained virtually unchanged since 2013, when Texas first had the option to expand Medicaid. As of 2019, 35% of the U.S. population had public health insurance, an increase of almost four percentage points from 2013.

Uninsured Rate for Nonelderly Residents

Another important measure of health care coverage is the uninsured rate for the nonelderly population — residents who are younger than 65 years old and not eligible for Medicare.

Over the last decade, the number of uninsured residents under 65 years old in Houston’s three-county region declined to a decade-low of 1 million in 2016 from a decade-high of 1.3 million in 2010. However, that number has steadily crept up to nearly 1.2 million uninsured in 2019. Harris County alone was home to nearly 1 million uninsured residents under the age of 65 in 2019.

Similarly, the uninsured rate dropped in each county during the last decade — peaking in 2010 and reaching the lowest levels in 2015 and 2016. However, despite this progress, uninsured rates in the region remain consistently higher than the U.S. average. More recently, between 2018 and 2019, the uninsured rate among the non-elderly population ticked up 1.8 percentage points in Fort Bend, 1.6 points in Harris, and nearly one point in Texas. In 2019, one out five people under 65 in Texas is uninsured (21%); one in four in Harris County (24%); 17% in Montgomery County; and 15% in Fort Bend County.

To learn about uninsured rates specifically for children, visit our Maternal and Child Health page.

Uninsured Rate for Nonelderly Adult Residents by Race/Ethnicity

Most people who remain uninsured are nonelderly adults age 19-64. In 2019, the uninsured rate among nonelderly adults was 28.4% across the three-county area.

Uninsured rates vary among racial/ethnic groups within Greater Houston’s diverse population. The uninsured rate among Hispanics in the three-county area (44%) is nearly four times that of whites (12%). Black adults also have a fairly high uninsured rate at 22%, which is higher than their rate for Texas and the U.S. Overall, nonelderly adults in Harris County have lower health insurance coverage rates, compared to Fort Bend and Montgomery counties.

The Kaiser Family Foundation identified several reasons why insurance coverage gaps differ and persist across race/ethnicity. For instance, people of color are more likely to live in low-income families that do not have coverage offered by an employer or to have difficulty affording private coverage when it is available. Additionally, uninsured nonelderly Hispanic and Asian people are more likely to be ineligible for coverage because of immigration status, reflecting higher shares of noncitizens among these groups.⁴

Primary care physician availability in the Houston region has improved slightly over the last decade

What factors affect access to health care? Sufficient availability of primary care physicians is crucial for preventative and primary care. Primary care physicians serve as the first point of contact with the health care system for many patients, thus they are more likely to be the first to screen major health-related conditions, detect early signs of disease and address health concerns at an early stage. Adults in the U.S. who have a primary care provider are more likely to report significantly better health care access and experience.⁵ They also have 19% lower odds of premature death than those who only see specialists for care.

Additionally, primary care also reduces overall costs. People with access to primary care providers are less likely to use an emergency room for care. It is estimated that the U.S. could potentially save $67 billion a year if everyone saw a primary care provider first rather than a specialist.⁶ Access to providers can be measured by the ratio of the total population to the number of primary care physicians. It represents the number of residents potentially served by a registered primary care physician in a county.

Although availability to primary care providers has improved slightly in Texas, the gap between the state average (1,642:1) and the national average (1,319:1) persists. In the three-county area, there were 3,779 registered primary care physicians in 2018. On average, for every 1,622 residents, there was one physician. The ratio of population to primary care physicians ranges from 1,709:1 in Harris County to 1,164:1 in Fort Bend County, indicating residents in Fort Bend County have more access to primary care providers than the other two counties. In the past seven years, access to primary care physicians has been improved steadily in Fort Bend County, passing both the state and national average. Montgomery County’s ratio, however, increased  to 1,674:1 in 2019 from 1,640:1 in 2010.

Read about challenges and availability of mental health care in the Houston area.

Preventable hospital stays in the Houston region have declined in recent years

Reducing preventable hospitalizations is critical for increasing quality of care and controlling costs. Medical conditions such as asthma and diabetes are considered ambulatory care sensitive conditions (ACSC). Generally, these conditions can be treated in outpatient settings by primary or preventative health care providers, which reduces the need for emergency room visits or inpatient hospitalization. Nationally, about 12.9% of inpatient hospital stays in 2017 were potentially preventable.

Data show that the majority of preventable hospital stays occur in patients aged 65 and older. Preventable hospital stays are measured by the number of hospital stays for ACSC per 100,000 Medicare enrollees in a given time period. High hospitalization rates for ACSC suggest a tendency of overusing emergency rooms and urgent care as a main source of care. It also places financial burdens on patients, insurance providers and hospitals as well.

In 2020, there were about 38,000 ACSC hospital stays and 756,000 Medicare enrollees in the three-county area, making its preventable hospitalization rate around 5,000 per 100,000 enrollees, higher than the national average. The rate for Montgomery County is the highest among the three counties and also higher than the state rate. However, the incidence rate of these stays has declined in each county in the region, in Texas overall and nationally between 2016 and 2018 — 12% in Fort Bend, 7% in Harris, 6% in Montgomery, 3% in Texas and 6% in the U.S. overall.

Preventable hospitalization rates also vary by racial/ethnic groups. Black residents have a much higher rate compared to Hispanic and white residents. The number of hospital stays for ACSC among Black adults in Montgomery County was 8,333 per 100,000 Medicare enrollees in 2018, almost double Texas’s average rate for all racial and ethnic groups (4,793).

This is not a new trend. Since 1998, racial and ethnic disparities in hospitalizations from chronic ACSCs have increased, resulting in over 430,000 excess hospitalizations among non-Hispanic Blacks compared to non-Hispanic whites.⁷ According to one study, Black adults had significantly higher rates of ACSC hospitalizations than white adults, even after controlling for demographic, socioeconomic, and geographic factors.⁸ There is no biological reason for race or ethnicity to predict preventable hospitalizations. Reasons for these persistent disparities include, but are not limited to, health care providers’ attitudes and internalized biases, disease stereotyping and clinical nomenclature, and clinical algorithms, tools, and treatment guidelines.

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Maternal & Child Health

Pregnant women and children in Houston’s three-county region have poorer health outcomes compared to national averages, jeopardizing the future well-being of mothers and their children

Overall infant and child mortality rates in the region are down, but we’ve seen declines in health and well-being in pregnant women, infant vaccinations and child nutrition over the last decade. Disparities have either widened or remained flat — the result of variation in underlying chronic conditions, disproportionate access to quality health care, and internalized bias in our health care system.

The data

Disparities in maternal and child health outcomes across racial/ethnic groups are deep and pervasive

Disparities in maternal, infant and child mortality and health have been evident for many years.⁶ Women of color, particularly Black women, consistently have the highest maternal mortality rates. Multiple factors contribute to these disparities, such as variation in underlying chronic conditions, access to quality health care, internalized bias and structural discrimination.

For a variety of environmental and social reasons, Black women are more likely to have pre-existing conditions such as obesity, heart disease, and diabetes prior to being pregnant, which increases pregnancy risks and the likelihood of maternal and child health issues.⁷ Further, the health care they receive is typically of lower quality — not only because of lower-quality health care establishments and caregivers⁸ but also because of implicit racial bias embedded in the health care system. For example, health concerns and reported pain from Black patients are more likely to be dismissed than those from white people.⁹ The Listening to Mothers Survey III found that one in five Black and Hispanic women reported poor treatment from hospital staff — citing factors such as race, ethnicity, cultural background or language — compared with 8% of white mothers.¹⁰

National data show that Black women are more likely to receive delayed prenatal care (after the first trimester) or none at all.¹¹ While Medicaid covers women who are pregnant, women must first learn they are with child, apply for coverage, and wait to be approved before they are able to seek care. By the time this happens, it could be after the first trimester of gestation.

Black women are also more likely to receive poor follow-up care after the baby’s birth or none at all.¹² Nearly 71% of women who died from pregnancy-related causes in Texas in 2013 died within one year after the baby was born, according to a 2020 report from the Texas Maternal Mortality and Morbidity Review Committee.

Black women have higher maternal mortality rates than white women even when income and education are controlled.¹³ This phenomenon led some researchers to theorize that extreme emotional and psychological stress can produce a sufficient physiological reaction, called “weathering,” that harms, or ages, the body and could lead to negative health outcomes, including maternal and infant mortality rates.¹⁴ Meaning, the compounding trauma and stress simply from being both Black and a woman could contribute to racial disparities and negative outcomes in maternal and child health. This could also explain why the mortality rate for Black mothers over 40 is nearly triple that for white mothers in the same age group.^15,16,17

The national maternal mortality rate jumped 37% between 2018 and 2020

One of the more troubling trends in health is the increasing number of women who die from pregnancy-related complications. The World Health Organization defines a pregnancy-related death as the death of a woman while pregnant or within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy.

The leading causes of pregnancy-related death in Texas include cardiovascular-related issues, mental disorders, hemorrhaging, and preeclampsia, characterized by extremely high blood pressure.The Texas Department of State Health Services estimates 89% of these deaths in 2013 could have been prevented.

Between 1987 and 2018, maternal mortality in the United States soared 140%. (Because of changes in methodology, data prior to 2018 cannot be compared with data for 2018 and after.)

In 2020, 861 women died of maternal causes (i.e., women who die from pregnancy-related complications while pregnant or within 42 days of giving birth) in the U.S., an increase from 754 in 2019. The maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births, up from 20.1 in 2019, and higher still from the 2018 rate of 17.4 — a 37% increase.

Texas’ maternal mortality rate is above the national average

Other wealthy nations are not experiencing the high rates of maternal mortality found in the U.S. In Canada, the maternal mortality rate is about 10 per 100,000 live births, while in the U.K. it is 7. The U.S. trend is also at odds with several less developed countries, where maternal mortality has declined.

The Texas maternal mortality rate in 2018 was 18.5 per 100,000 live births, above the U.S. average of 17.4. When data between 2018 and 2020 are combined, the Texas maternal mortality rate is 22.9 — still higher compared to 20.4 overall in the U.S. Among the 30 states for which a rate was calculated, Texas ranks in the middle, with the highest rate in Arkansas (40.4) and the lowest rate in California (10.2).

Maternal mortality rates vary drastically by both race/ethnicity and age. In 2020, the maternal mortality rate for Black women was 55.3 deaths per 100,000 live births. This is not only nearly three times the rate for white women (19.1), but it is also 1.5 times the rate from two years earlier in 2018 (37.3 deaths per 100,000 live births).

Typically, the younger the woman’s age, the lower the mortality rate. The maternal mortality rate per 100,000 live births was 13.8 for all women under 25 years of age, 22.8 for women between 26 and 39, and 107.9 for women 40 and older. However, Black women under 25 are still 1.5 times more likely to die than white women between 25 and 39 years of age.

Women over 40 face a much higher rate of maternal mortality than women under 40. Black women across all ages experience higher rates of maternal mortality. In 2020, Black women over the age of 40 had a maternal mortality rate of 263.1 per 100,000 live births, nearly triple the rate for white women in the same age group (96.8).

What is maternal morbidity?

The World Health Organization defines maternal morbidity as any health condition attributed to and/or aggravated by pregnancy and childbirth. Maternal mortality can be too small (statistically) to see meaningful trends at smaller geographies, so researchers often cite severe maternal morbidity. Severe maternal morbidity can be considered “a near miss” for maternal mortality and refers to unexpected outcomes of labor and delivery resulting in significant short- or long-term consequences to a woman’s health.¹⁸

Between 2008 and 2015, Harris County’s incidence of maternal morbidity increased 53%, compared to a 15% percent increase for Texas overall. In order to address this rise in Texas, in 2021 lawmakers passed a bill expanding postpartum Medicaid coverage from two months to six months, but many advocates hoped for a full year of health coverage to reflect the long-term impact of giving birth on a woman’s body. Similar to maternal mortality, maternal morbidity in Texas has significant variation in rates across racial/ethnic groups.¹⁹

Pregnant women in Fort Bend and Harris counties access prenatal care in their first trimester at lower rates than the state and nation

Early prenatal care is defined as pregnancy-related care beginning in the first trimester (1-3 months). It has been viewed as a strategy to improve pregnancy outcomes for more than a century.

Nationally, less than 2% of pregnant women received no prenatal care during their pregnancy in 2020. In Texas, the rate was double at 4%. In the three-county area, the rate of no prenatal care ranged from 5.6% in Harris County to 3.2% in Fort Bend and 1.5% in Montgomery in 2020.

While none of the three counties is considered maternity care deserts, a lack of health insurance is the largest contributor to women delaying or not accessing prenatal care.²⁰ While Medicaid covers women who are pregnant, women must first learn they are with child, apply for coverage, and wait to be approved before they are able to seek care. By the time this happens, it could be after the first trimester of gestation. In an analysis of national data, researchers found women with Medicaid were less likely to begin prenatal care in the first trimester and were less likely to receive adequate prenatal care compared to privately insured women.²¹

More than 77% of pregnant women in the U.S. received prenatal care in the first trimester in 2020, unchanged since 2016. While early prenatal care has slightly increased recently in Texas to nearly 70% in 2020 from 67% in 2016, it remains below the national rate. In fact, Texas was ranked last in the country for early prenatal care in 2016, according to the most recent report on the topic from National Center for Health Statistics.

Regionally, pregnant women in Montgomery County receive early prenatal care at higher rates, 73% compared to 60% in Fort Bend and Harris counties. The rate of early prenatal care in Harris County has not improved since 2016, and the rate in Fort Bend has declined by more than 10 percentage points from 2019 to 2020.

Overall infant mortality in the Houston-area has ticked down in the last decade, though racial disparities have widened

Infant mortality is defined as the death of a baby before their first birthday, and it is regarded as a strong indicator of the overall health of a population. The five leading causes of infant death are congenital malformations, low birth weight, maternal complications, sudden infant death syndrome (SIDS), and unintentional injuries. The health of the mother, level of prenatal and postnatal care, and access to health care also influence infant mortality.²²

Infant mortality rates are highest among infants born to teenage moms and women over 40. Babies born to mothers with obesity or mothers who smoke or consume alcohol during pregnancy also have a greater risk of infant mortality, particularly during the first 28 days after birth.^23,24,25

The infant mortality rate in the United States was 5.6 deaths per 1,000 live births in 2019. Despite the progress made to reduce infant mortality in the past decades, the national rate is still higher than that of other developed countries. Data from Organization for Economic Co-operation and Development (OECD) shows the 2021 infant mortality rate in the U.S. is higher compared to several nations, including Russia, Canada, the Netherlands, France, Poland, United Kingdom, South Korea, and Estonia.

What is the infant mortality rate in Texas? Houston’s three-county region?

Infant mortality in Texas was 5.6 per 1,000 live births in 2017–19, slightly lower than the national average. Locally, the highest infant mortality rate is in Harris County, and the lowest rate is in Fort Bend County. While infant mortality rates over the past decade have dipped in Texas, they have remained relatively flat in Harris County. Wide disparities exist among racial groups, for many of the same reasons described above.

In Harris County, the infant mortality rate for babies born to Black mothers is three times that for babies born to white women. While the infant mortality rate in Harris County for white women has remained relatively flat, it has worsened for Black women — up 26% between 2011 and 2018. The racial disparity in infant mortality rates in Harris County is nearly 1.5 times the gap at the state and national level.

Among the three regional counties, the mortality rate in 2018 for babies born to Black mothers was highest in Harris County (11.19 per 1,000 live births) compared to the nation (10.6) and Texas (9.9). This is different from what we see among white mothers. The mortality rate in 2018 for babies born to white mothers was lowest in Harris County (3.7 per 1,000 live births) compared to Texas (4.5) and the nation (4.5).

Continue reading about disparities in life expectancy in Texas and how it varies across neighborhoods in Houston’s three-county region. 

Babies born to mothers in Fort Bend and Harris counties tend to have the lowest birth weights in the region

Newborns weighing less than 2,500 grams, or 5.5 pounds, are considered low birth weight. In addition to the high risk of infant mortality, infants with low birth weight also face short- and long-term health conditions that can permanently affect their quality of life, such as intestinal disorders, learning and behavioral problems, and type 2 diabetes.^26,27

The most common causes of low birth weight are premature birth (birth prior to 37 weeks gestation) and restricted fetal growth (when a fetus is smaller than expected for its gestational age). Environmental risk factors contribute to fetus development — exposure to air pollution (both indoor and outdoor) and drinking water contaminated with lead are also found associated with low birth weight.²⁸ This has significant implications since communities of color and low-income communities are more likely to be exposed to contaminated air and water, due to years of systemic environmental racism. Additional risk factors such as smoking or drinking alcohol during pregnancy may also lead to slower fetus development even if the baby was born full-term.

Continue reading about water and air pollution in Houston.

Nationally, the percentage of infants born with low birth weight has ticked up slightly to 8.24% in 2020 from 8.15% in 2010. Regionally, 8.26% of babies in Fort Bend County, 8.72% in Harris County, and 6.79% in Montgomery County were born with low birth weight in 2020. Low birth weight is more prevalent among babies born to Black women than those born to Hispanic or white women, even when controlling for education, according to a national analysis.²⁹ Again, this can be attributed to many of the same aforementioned reasons.

Vaccination rates in Houston and Texas have fallen while they have risen nationally

Immunization is a safe and cost-effective means of preventing illness in young children and interrupting disease transmission within the community.

The seven-vaccine series provides immunization against diphtheria, pertussis, tetanus, poliovirus, measles, mumps, rubella, hepatitis b, hemophilus influenza b, chicken pox, and pneumococcal infections. The seven-vaccine series indicator measures overall compliance with the recommendations of the Advisory Committee on Immunization Practices (ACIP) for young children.

For children born in 2017 and 2018, the seven-vaccine coverage rate by age 24 months was 70.5% in the U.S. In Texas, the rate was lower at 65.9%, and in the city of Houston, the rate was 65.2%.

Coverage by age 2 was lower for most vaccines among children who did not have private health insurance. Coverage was lower for both Black and Hispanic children compared with white children for most vaccines. The lowest coverage was for the influenza vaccine (60.6%).³⁰ Research suggests racial disparities in vaccine uptake could be due to overall lower insurance rates, apprehensions or distrust of the health care system, or misconceptions about vaccine efficacy.³¹

Child mortality rates are highest in Harris County and lowest in Fort Bend

Because of advances in medicine over the last half of the 20^th century, child mortality has declined so much that even though youth comprise a quarter of the U.S. population, they represent less than 2% of all deaths.³² The leading causes of death among children and adolescents include accidents, assaults, suicide, and cancer.³³

In Texas, 48.6 per 100,000 children die before their 18th birthday. Within Houston’s three-county region, child mortality rates are highest in Harris County (51.4 per 100,000) and lowest in Fort Bend (31.6).

Child mortality rates for Black youth are consistently the highest compared to other race/ethnicity groups. Mortality rates in Harris County among Black children are the highest (96.5 per 100,000) — nearly 2.5 times that of white children. Even with the overall decline in child mortality in the U.S., racial disparities continue and are greatest for certain medical conditions that are sensitive to delays in medical care, suggesting poor access to health care and mental health care in the Houston area.³⁴

Nearly 232,000 Houston-area children do not have health insurance

Goals for maternal and child health don’t end after the postnatal period. While maternal and child health is focused on the health of mothers during pregnancy, childbirth and the postnatal period — defined as up to one year after birth, the field of study also covers a child’s health during these stages and the first five years of life — the most important time of early childhood development.

Children may receive health insurance coverage from a variety of sources, including private insurance or public programs such as Medicaid and the Children’s Health Insurance Program (CHIP). However, some have no insurance at all. In 2020, 4.3 million American children under the age of 19 did not have access to health insurance coverage.

Nearly one million children in Texas do not have any form of health insurance coverage — about one in eight. Nearly 232,000, or 23%, of Texas’s uninsured children reside in Houston’s three-county region. The level of uninsured children in the Houston area (13.6%) is slightly higher than in Texas (12.8%), which is double that of the nation overall (5.7%). Fifteen percent of children in Harris County do not have insurance — the highest rate in the region — compared with 9.1% of children in Fort Bend and Montgomery counties.

Consistent with coverage trends among adults, Hispanic children in the Houston region have the highest uninsured rates. One out of five Hispanic children in Harris County does not have health insurance compared to one out of 15 white children. One out of eight Black children in Montgomery County does not have health insurance.

Children from low-income families may be able to get access to health insurance coverage through Medicaid and CHIP.

On average in 2020, 3.2 million children in Texas were enrolled in Children’s Medicaid and CHIP. The COVID-19 pandemic caused an increase in Medicaid/CHIP enrollment across the country. Texas saw a 23% increase in Medicaid/CHIP enrollment from February 2020 to September 2021. In State Fiscal Year 2020,³⁵ nearly 633,000 children enrolled in Medicaid, and 80,000 children enrolled in CHIP each month in the three-county region.

Food insecurity among children was in decline prior to the pandemic

The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to adequate food for a healthy life. Children who do not have enough to eat tend to experience lifelong health problems. Food insecurity has been found to not only have clear and consistent harmful impacts on children’s general health, chronic health, and acute health,³⁶ but also on their physical, behavioral and brain development.³⁷

Feeding America provides estimates for food insecurity at different community levels. Using the relationship between food insecurity and its closely linked indicators (poverty, unemployment, homeownership, disability prevalence, etc.) an estimated food insecurity rate is generated.

In 2020, 11.7 million (16%) children in the U.S. were food insecure, a rate higher than the general population (11.8%).³⁸

According to Feeding America, child food insecurity in the Houston area fell from 2017 to 2019. However, the effects of COVID-19 were estimated to have led to an increase in food insecurity in 2020, which remained elevated in 2021. Feeding America estimates one in four children in Harris County are food insecure — about a quarter of a million children.

More than a third of City of Houston and Texas high school students are overweight or have obesity

Even when children have enough to eat, they may have poorer nutrition or eat lower-quality food as budget constraints may prompt families to purchase cheaper, more energy-dense foods.³⁹ Childhood obesity is defined as having a body mass index (BMI) at or above the 95th percentile for their gender, according to the CDC sex-specific BMI-for-age growth charts. About 18.5% or 13.7 million children and adolescents in the United States have obesity, putting them at higher risk for poor health.⁴⁰

In 2018, the obesity rate in Texas for children who are 2-4 years old and are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was 15.9%. While this is one percentage point lower than the 2010 rate, it remained above the national level of 14.4%.

The percentage of American high school students who are overweight ticked up from 15.2% in 2011 to 16.1% in 2019. In Texas, that rate increased nearly two percentage points to 17.8% during the same period. About 18.8% of high school students who live within the city of Houston are classified as overweight. Obesity rates in Houston grew faster than the rate of those who are overweight — an additional 19.5% of high school students have obesity, an increase of six percentage points since 2011. Combined, 38.3% of high school students in Houston are either overweight or have obesity compared to 34.7% in Texas and 31.6% nationally.

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Mental Health

Mental health conditions are common in the region, yet residents struggle to access mental health services in Houston

Our region has seen a recent increase in mental distress frequency, drug use and suicides, exacerbating the existing mental health challenges across the Houston region. While the number of mental health care workers per resident has improved, our region’s access to professional mental health help remains significantly lower than the national rate.

The data

One out of 13 adults in Texas experience a major depressive episode

Mental illnesses are common in the United States. About 21% of U.S. adults (52.8 million) lived with a mental illness in 2020. The prevalence of mental illness was higher among women (25.8%) than men (15.8%). Young adults aged 18–25 had a higher prevalence of mental illness (30.6%) than older adults (19.5%). White adults are more likely to report mental health issues than people of color.³ However, the consequences of mental illness in people of color may be more persistent, meaning even though they might have lower rates, they are less likely to seek mental health treatment (or receive effective treatment), and their mental health conditions might not improve over time.⁴ Lack of cultural understanding by providers and social stigma may contribute to the underdiagnosis of mental illness among people of color and the immigrant population. Mental health problems are also common among people in the criminal legal system. Estimates suggest between 50% to 75% of youth in the juvenile legal system meet the criteria for a mental health disorder.⁵

Mental illness varies in levels of severity. Serious mental illness is defined as a mental, behavioral or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities. Nationwide, 5.2% of adults (13.1 million) experienced serious mental illness in 2019.

Not only young adults, but youth aged 12–17 also report higher levels of serious mental illness compared to older adults. In 2019 and 2020, 16.4% of kids aged 12-17 reported having a major depressive episode — one of the most prevalent serious mental illnesses affecting both youth and adults. This is similar to the rate seen in young adults aged 18-25, but lower than that in adults aged 26 and up (6.9%). In Texas, the rates for youth experiencing a major depressive episode is 17.1%, higher than the U.S. average.

The economic costs of mental illness can be broken into two categories: direct and indirect. The direct costs include medication, therapy, and hospitalization or other outpatient treatment. Indirect costs accounts for lost productivity and income loss.⁶ Depression alone is estimated to account for $44 billion in losses to workplace productivity.⁷ It has been estimated that the economic costs of severe mental illness reached $317 billion in the U.S.⁸ For individuals with a severe mental illness the lifetime financial burden is $1.85 million.⁹

Overall, a national analysis of states across seven measures ranked Texas 13^th for the prevalence of mental health, indicating a lower number of mental illness and substance abuse cases among the Texas population compared to other states and districts. In Texas, 16.3% of adults (3.3 million) are experiencing a mental illness, compared to 18.6% nationally. However, among youth experiencing severe major depression, Texas ranked in the middle of the list, with 9% of the youth population (211,000) coping with depression, which often co-occurs with other issues like substance abuse or chemical dependency, anxiety and disorderly behavior.

COVID-19 and natural disasters have a significant impact on our mental health

By any measure, COVID-19 has made 2020 and 2021 very challenging years. Almost 75% of adults reported the pandemic had a negative effect on their emotional or mental health. Children may be particularly at high risk for longer term anxiety and depression as a result of the pandemic.

The proportion of adults in the Houston Metropolitan Statistical Area (MSA) that have felt nervous, anxious, or on edge for at least more than half the days of a week has remained elevated throughout the pandemic. A Census Bureau survey found that at the end of Summer 2021, 24% of adults reported anxiety symptoms for at least half the days of the week — similar to rates from the beginning the survey began in Spring 2020.

Beyond COVID-19, disasters have been shown to affect mental health.¹⁰ In recent years, Houstonians have experienced a number of events that have had negative effects on their mental health — namely the seven federally declared natural disasters in Houston that have occurred since 2015. For example, following Hurricane Harvey, residents experienced an increase of 1.3 days a month of poor mental health.¹¹

Residents in the Houston region report an increase in mental distress frequency

The average number of mentally unhealthy days — days involving significant amounts of stress, depression or other emotional distress — is a self-reported quality-of-life measure. Research has shown that it is a reliable estimate of an individual’s recent mental health condition and a predictor of future adverse health events. Counties with more unhealthy days were likely to have higher unemployment, poverty, and undesirable educational and health outcomes than counties with fewer unhealthy days.¹²

Between 2016 and 2019, the average number of mentally unhealthy days increased in Texas and the U.S. overall. The national average number of poor mental health days reported in the past 30 days was 4.5 in 2019, an increase from 3.8 in 2016. While Texas has a lower average number of poor mental health days at 4.2, it’s almost a full day increase from 3.4 days in 2016.

In general, the three-county area reports slightly fewer mentally unhealthy days than the national average. Adults in Harris County reported an average of 3.6 days in 2019 with poor mental health — the lowest among the three counties — while adults in Fort Bend and Montgomery counties reported an average of 3.9 and 4.2 days, respectively. The average number of mentally unhealthy days in Fort Bend and Montgomery counties increased almost a full day between 2016 and 2019, while Harris County remained relatively unchanged.

Adults who experience frequent mental distress are those who report 14 or more days of poor mental health in the past month. Research has found a strong relationship between frequent mental distresses and clinically diagnosed mental disorders, such as depression and anxiety.¹³ Frequent mental distress is associated with unhealthy behaviors such as smoking and physical inactivity, risk factors such as housing and food insecurity, and is more common among women.^14,15

The proportion of adults experiencing frequent mental distress in Texas increased to 12.1% in 2019 from 10.6% in 2016. Harris and Montgomery County have a higher percentage of adults who reported 14 or more days of poor mental health in a one-month period in 2019 (13.1% and 13.6%) compared to Fort Bend County (10.9%).

Many factors contribute to mental health, including our biology, personal experience and family history. However, certain populations experience a higher frequency of mentally unhealthy days.

Both in Texas and in the nine-county Houston Metropolitan Statistical Area, women experience more days of poor mental health than men. The Black population in Texas is more likely to report five or more days of poor mental health, compared to white and Hispanic populations. In contrast, Hispanic residents in Houston are more likely to have reported five or more days of poor mental health.

Substance abuse in the Houston region has increased

Alcohol consumption has been linked to poor mental health. People may use alcohol to relieve symptoms of stress, anxiety, and depression, but long-term alcohol use and binge drinking often leads to a worsening of mental health.¹⁶

Residents in the Houston area reported similar levels of binge drinking as the national average in 2019. About 15.5% of adults in Fort Bend reported binge drinking in the month compared to almost 18% in Harris and Montgomery counties and the U.S. overall.

In the U.S., more than one in four adults living with mental health problems also has a substance use problem. These issues affect people across the country regardless of background or age.

In Texas, the rate of illicit drug use in 2019-20 is lower for all ages compared to the nation. About 24% of American young adults between 18- and 25-years-old reported using illicit drugs in 2020 compared to 16% in Texas. However, drug use among adults older than 25 increased by 2 percentage points in the state and 2.4 points in the country between 2017-18 and 2019-20.

Rates and levels of suicide in the Houston region are on the rise

Mental health disorders can lead to suicide, though the the majority of people who struggle with their mental health do not go this route — estimates indicate about 5-8% of people with a mental health condition attempt suicide,^17,18 though about 46% of people who die by suicide had a diagnosed mental health condition. In addition to mental health conditions, environmental risk factors such as prolonged or extreme stress and access to firearms or drugs can increase risk of suicide. Historical factors such as suicide attempts, childhood abuse and family history of suicide can also increase the risk.¹⁹

In 2020, suicide was the 11th leading cause of death in the U.S. However, it was the second leading cause of death among American youth and young adults, ages 10–34.

Suicide accounted for the loss of 2,735 lives in the three-county area between 2017 and 2020, an increase of 15% compared to the time period between 2013 and 2016. Between 2001-04 and 2017-20, the number of suicides has increased 139% in Fort Bend County, 40% in Harris County, and 107% in Montgomery County. However, Fort Bend and Montgomery counties have also experienced substantial population growth during that time period.

In order to account for population differences, the number of suicides per 100,000 people in the region (suicide rate) is a better indicator of suicide prevalence. The suicide rate has also increased over the last two decades to 11.2 per 100,000 residents from 10.3 in 2001-04. This rate remains lower than in Texas, where there were 16.3 suicides per 100,000 residents in 2017-20. Between 2001 and 2020, the suicide rate increased 30% in Texas.

Montgomery County’s suicide rate in 2017-2020 is the highest in Houston’s three-county region at 16.3 suicides per 100,000 residents — much higher than Fort Bend (10.4) and Harris (10.7) counties, although Harris County has the highest total number of suicides in the region.

While mental illness is more prevalent among women, men are more likely to attempt suicide, and they die by suicide at a rate 3.6 times that of women. In particular, white males account for most suicides across all age groups.

The suicide rate per 100,000 men during the 2017–2020 period is 10.7% higher than that during the 2013–2016 period in Texas. The suicide rate per 100,000 males in Montgomery County is 26.4, well above the rate of 21.7 for the state overall.

Availability of mental health services in Houston has improved, but remains lower than national rates

Nearly one in five adults has some form of mental health condition, contributing to increased financial costs, disability and death rates in recent years.²⁰ However, the availability of mental health resources remains stagnant, as the supply of mental health providers cannot keep up with growing needs. In fact, about 136 million people across the country live in mental health professional shortage areas (HPSAs). And in Texas, more than 15 million people live in HPSAs, with only 32.9% of the need being met. These challenges are layered on top of low coverage rates for health insurance in Houston and across the state.

Mental health care providers include psychiatrists, psychologists, licensed clinical social workers, counselors, family therapists, providers that treat substance abuse and chemical dependency, and advanced nurse practitioners specialized in mental health care. These professionals provide essential care to both adults and children who have a mental disorder. To measure access across geographic units with different population sizes, we use the ratio of the population to mental health providers. The higher the ratio, the lower the access to mental health providers.

Typically, mental health professionals are concentrated in urban areas. About 7,700 registered mental health providers were practicing in Houston’s three-county area in 2021, a 39% increase from 2017, and availability has improved across all geographies over this time period. This translates to roughly 800 residents for every one provider — slightly lower availability than the state (759:1) and below half the mental health provider availability seen across the nation (350:1). In fact, Texas is at the bottom of national rankings for access to mental health treatment. Among the three counties, Harris County’s mental health services are more accessible than those in Fort Bend or Montgomery counties. Low-income areas and rural communities have less access to mental health care in Houston because of fewer mental health treatment facilities and providers in general.²¹

Helpful Articles by Understanding Houston:

• It’s “Okay to Say™” That You or a Loved One Have a Mental Illness
• NAMI Executive Director, Advocate for a Broader Perspective on Mental Illness
• Key Insights From Our Mental Health Data Dive + Workshop
• Children’s Mental Health in the Context of the COVID-19 Pandemic
• Houstonians’ Experiences with Hurricane Harvey and the COVID-19 Pandemic

Health Risks & Health Outcomes in Houston

Despite reductions in cancer mortality and lower rates of premature death than the state and nation, a sizable percentage of Houstonians continue to experience poor physical health and well-being

More Houstonians have become sedentary, food insecure, unwell, obese and diabetic in recent years, with people of color disproportionately burdened by health challenges. These outcomes ultimately lead to a decline in quality of life and contribute to the most common causes of death.

The data

More than one out of four adults in the Houston region does not get enough exercise

Physical inactivity can have serious impacts on a person’s health. Low levels of physical activity can increase the risk for diseases, including cardiovascular diseases, diabetes and obesity, hypertension, cancer, depression, and anxiety.³ In addition, physical inactivity is associated with reduced  expenditures on health care treatments for circulatory system diseases.⁴

About 26% of adults across the U.S. reported no physical activity in 2019, as did 27% of Texans. Adults in Fort Bend County were slightly less likely to report no leisure-time physical activity compared to those in Harris and Montgomery counties, where the rates were higher than both with the state and nation.

Research shows that trends in physical activity correlate strongly with income and education level, a finding consistent with Texas trends as well.⁵ On average, those with lower household incomes and lower levels of educational attainment were more likely to be physically inactive.⁶ Research from the Robert Wood Johnson Foundation suggests this is because people with more education tend to have higher paying jobs, which allows them the option to live in neighborhoods that have lower crime rates and greater access to recreational facilities. Additionally, people with high levels of educational attainment are more likely to work one job only, which affords them more time for recreational activities. Because of the high correlation between race and income/education, it is not surprising that Black and Hispanic adults in Texas are more likely to be physically inactive than white adults, according to Behavioral Risk Factor Surveillance System (BRFSS) data from the Texas Department of State Health Services; in 2020, about 78.4% of white Texans engaged in recreational physical activity compared to 72.4% of Black and 70.2% of Latino Texans. Additionally, women in Texas are more likely to be physically inactive than men by 3.5 percentage points.

Prior to the pandemic, food insecurity in the Houston region was in decline

The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to adequate food for a healthy life. In 2020, more than one in 10 Americans were food insecure (10.5%). That is equivalent to about 38 million people, including more than 11 million children.⁷ Food insecurity is most common amongst people living below the poverty line, people of color, single adults and single-parent households. Although food insecurity is closely related to poverty, people living above the poverty line may also experience food insecurity.

Feeding America provides estimates for food insecurity at different community levels. Using the relationship between food insecurity and its closely linked indicators (poverty, unemployment, homeownership, disability prevalence, etc.) an estimated food insecurity rate is generated.

According to Feeding America, the food insecurity rate declined in Houston’s three-county area between 2017 and 2019. However, the effects of COVID-19 in Houston led to an increase in the estimated food insecurity rate in 2020, with effects continuing into 2021. These estimated effects mirror the high food insecurity rate found by the Household Pulse Surveys conducted by the U.S. Census Bureau. Feeding America estimates that food insecurity is highest in Harris County and lowest in Montgomery County, and Texas has a higher rate than the national average. It is important to note that in the U.S., children are more vulnerable to food insecurities, 16.1% compared to 11.8% for all individuals.

Predicting healthy outcomes: nearly one out of four adults in Harris County rates their health as “fair” or “poor”

How one rates their own health is a reliable indicator of a person’s overall physical state and well-being and has been found to be a strong indicator of mortality.⁸ People who rate their health as “poor” had twice the mortality risk, compared with those with “excellent” self-rated health.⁹ This measure is found to be closely correlated with the results of physical exams by health providers.¹⁰

Harris County had the highest proportion of adults who rated their current state of health as “fair” or “poor,” at 23% in 2019, compared to 16% in Fort Bend County and 19% in Montgomery County. The percentage of adults in Harris County who considered themselves to be in poor or fair health was also higher than the state, which was higher than the national average. Rates of “fair” or “poor” health grew about two percentage points in the three-county region and Texas between 2018 and 2019.

Another way to predict healthy outcomes and to measure for health-related quality of life is the average number of physically unhealthy days in the past 30 days, which shows how people rate their recent health. A study on the number of healthy days reported in a county found that counties with more unhealthy days were likely to have higher unemployment, poverty, percentage of adults who did not complete high school, mortality rates, and prevalence of disability than counties with fewer unhealthy days.¹¹

In 2019, Texas had slightly fewer physically unhealthy days compared to the nation, 3.6 and 3.9 respectively. Residents in Fort Bend County (3.1) reported fewer physically unhealthy days than both the state (3.6) and nation (3.9), whereas Harris County reported the most unhealthy days (4.0).

The obesity rate in Houston: nearly one-third of adults in the region have obesity

Obesity, defined as having a body mass index (BMI) of 30 or more, is a complex health condition affecting both adults and children. Obesity increases the risk for health conditions such as coronary heart disease, type 2 diabetes, cancer, hypertension, and more.

Among all the “modifiable” behavioral risk factors, obesity is found to take more years of life than diabetes, tobacco use, hypertension or high cholesterol. Obesity also has significant economic consequences. On average, adults with obesity spend $3,429 more per person annually on medical expenses than those with medically healthy weights.¹²

Obesity rates continue to increase across the nation and Texas. In 2020, 35.8% of adults aged 18 and older in Texas are considered obese, and that share of the population is higher than the national average (31.9%). The proportion of adults 18 years and older who are classified as obese increased five percentage points in Texas and three points in the U.S. in the last decade.

What about the obesity rate among Houston’s population? Despite some fluctuations over the last decade, obesity rates in the Houston region continue to rise. According to the most recent estimates, one in three adults aged 20 and over in Montgomery County are considered obese — the highest rate among the three counties — and significantly higher than in 2011 when one in five adults were obese (the lowest rate in the region at the time). Fort Bend County has the lowest obesity rate in the region at 28.6%, which is about five percentage points higher than it was in 2011. Obesity rates in Harris County have ticked up to 31% in 2019 from 28% in 2011.

Adults 65 years and above have the lowest obesity rate, but one in three was still considered obese in 2020 — an increase of eight percentage points from the year before. Nearly half (47.7%) of adults between 45 and 64 years of age in Harris County were classified as obese in 2020 — a seven-point increase from 2019.

Obesity in Harris County is more prevalent among individuals with less education. About 25% of college-educated adults are obese compared to 42% of people with a high school diploma only or some college education.

In terms of income, half of adults in Harris County who earn less than $25,000 annually are obese compared to about one-third of higher-earning adults.

And, consistent with national trends, obesity rates are highest among Hispanic/Latino and Black adults in the county (43.5% and 41.2%, respectively). However, one in three white adults also experienced obesity in 2020, which is a 10-percentage-point increase from the year before.

In 2020, obesity rates rose for all demographic groups compared to 2019, except for those with a college degree. Children also experience health risks associated with obesity.

Continue reading about maternal and child health in Houston

The prevalence of diabetes in the Houston region has ticked up in the last decade

Diabetes is the seventh leading cause of death in America, accounting for over 100,000 or 3% of total deaths in 2020. About 1 out of 10 Americans (more than 37 million people) have diabetes, and 90-95% of them are diagnosed with type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC). An additional 96 million U.S. adults are pre-diabetic — where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes — and over 80% are not aware they are headed toward a full diabetes diagnosis. The total medical costs and lost work and wages for people with diagnosed diabetes was estimated at around $327 billion yearly.

The percentage of adults in Texas with diabetes increased to 12.0% in 2018 from 10.3% in 2011. The percentage of adults with diabetes in Texas is consistently higher than the national rate, which stood at 8.3% in 2019 — a slight decline over 2018 (9.1%).

The percentage of adults aged 20 and older with diagnosed diabetes in the Houston region is in the top quartile of the state. In 2019, Fort Bend and Harris counties both had 10.2% of adults over 20 years of age diagnosed with diabetes. Prevalence of diabetes in the region has ticked up about two percentage points since 2011.

As of 2019, men in all three counties were more likely to have diabetes than women. The difference is most pronounced in Montgomery County. National statistics also show the racial differences in the prevalence of diagnosed diabetes. Overall, people of color have higher rates of diabetes compared to white adults.

Cancer mortality and incidence rates in Houston’s three-county region have declined over the past decade

In 2020, over 600,000 people in the U.S. died of cancer, making it the second leading cause of death in the nation. In 2018, the latest year for which incidence data are available, 1.7 million new cases of cancer were reported in the United States. According to the latest national statistics from the CDC, cancer death rates have decreased 27% in the past 20 years. Reasons for this overall decline can be attributed to several factors, including the rapid decrease in lung and melanoma deaths.

Cancer mortality rates have fallen in Houston’s three-county region, and the rates for all three counties are lower than the U.S. and Texas rate.

Between 2010 and 2018, the cancer mortality rate in the United States dropped from 171.8 deaths per 100,000 people to 149.2 per 100,000, a decline of 13.2%. During the same period, the cancer mortality rates for Fort Bend County fell by more than 22% — faster than the state and the nation. Harris and Montgomery counties also experienced a decline over the same time at 13.3% and 15.3%, respectively. At 111 deaths per 100,000, Fort Bend’s cancer mortality rate is already below the Healthy People 2030 target of 122.7 deaths per 100,000.

Risk of cancer and cancer mortality is affected by many behaviors, diseases and genetic factors. It is also influenced by health disparities in socioeconomic status and access to care. In general, men had higher rates of cancer mortality than women, and Hispanic and Asian-American residents had lower cancer mortality rates than Black or white residents in 2018.

In a similar fashion, age-adjusted cancer incidence rates in the three-county area are lower than the state and national rates. Additionally, annual rates of new cancer cases have declined in the past few years. In Texas, over 120,000 cancer cases were reported in 2018, equivalent to 409 cases for every 100,000 people, lower than the national rate of 436 per 100,000 people. In the three-county area, a total of 22,407 new cancer cases were reported in 2018.

Cancer clusters

A “cancer cluster” refers to a greater than expected number of cancer cases that occur within a group of people in a geographic area over a defined period of time, according to the CDC. In 2019, the Texas Department of State Health Services (DSHS) identified a cluster of lung and throat cancers among adults between 2000 and 2016 in the communities of Fifth Ward and Kashmere Gardens in North East Houston. In an analysis one year later, an additional cancer cluster was found in the same neighborhoods when children were diagnosed with leukemia at five times the state rate during the same time period. While direct causation has not been established, the clusters have been found near a rail yard site known to be contaminated by creosote, a probable cancer-causing substance, according to the Environmental Protection Agency, which created a toxic plume underneath more than 100 properties. Learn more about cancer clusters in Texas here.

Life spans vary by 23 years within the Houston region

Life expectancy is a reflection of the mortality patterns of a population and is a common measure used to describe overall public health across different communities. It refers to the average number of years one person can expect to live (from a specified age) based on the age-specific mortality rates of the population.

Across the country, life expectancy from birth has increased by decades over the past 120 years. The greatest improvements occurred in the first half of the 20th century. Since then, life expectancy has steadily and consistently increased, though at a slower rate. Until the COVID-19 pandemic.

Life expectancy in the U.S. fell to 77.0 years in 2020 from 78.8 in 2019. This reduction of 1.8 years of life was the largest single-year decline in more than 75 years. In addition to COVID-19, the decline was also attributed to the increase in deaths from unintentional injuries, heart disease, homicide, and diabetes.

While life expectancy has grown for both Black and white Americans, a gap between the two groups remains. In 1900, the gap was nearly 15 years, but that has narrowed to 3.5 years in 2017.

What are life spans like for the population in Houston? Overall, residents in Houston’s three-county area live slightly longer than the state average (78.4). Across the three counties, the life expectancy for residents of Fort Bend County (82.3 years) is higher than that of Harris (79.2) and Montgomery (79.5) counties. Life expectancy remained essentially flat from the combined years 2015-2017 to 2018-2020.

Disparities in life expectancy among race/ethnicity continue in Harris County, with white residents living an average of five more years  than Black residents. How long we live depends on a variety of interrelated factors, including genetics, whether one accesses medical care, and quality of nutrition. More significantly, however, is the fact that established research has found direct links among health, economic opportunity, race, and place, both nationally and locally.¹³ Put another way, differences in life expectancy are closely related to socioeconomic opportunity, which is why we see disparities in life span across race/ethnicity, income level, and place.

It is also worth noting that Hispanic residents in the region average longer lifespans than white residents by three to six years, despite the fact that Hispanics tend to have greater economic insecurity and uninsured rates, a national phenomenon known as the “Hispanic paradox” or the “Latino Mortality Advantage.”¹⁴ While more research is necessary, research suggests the counter-intuitive outcome can be attributed to lower smoking rates, family structure and strong social networks among Latinos.¹⁵ However, some research also suggests this advantage could disappear as the prevalence of obesity and diabetes increases among Latinos.¹⁶

Comparing life expectancy to income reveals the extent to which higher income is associated with greater longevity. Nationally, research has shown that the richest men live 15 years longer than the poorest men, while the gaps in lifespan between the richest women and the poorest women is 10 years.¹⁷

Further, life expectancies vary depending on where one lives within the three-county area — by as much as 23.4 years. Residents in a high-poverty East Houston neighborhood have the lowest life expectancy in the three-county area (65.7 years). On the other side of the spectrum, a wealthy neighborhood in the Clear Lake area near Bay Oaks Country Club has the longest life span of 89.1 years. This gap between low-income areas and their high-income counterparts is almost equivalent to the difference between low-income developing countries and high-income developed countries.

Continue reading about health in Houston, including mental health and access to health care

Total deaths in the Houston region rose significantly in 2020

There were nearly 3.4 million deaths in the U.S. in 2020, an increase of over half a million from 2019. The number of deaths attributed to COVID-19 was 350,831, making it the third leading cause of death in the nation, state, and Houston’s three-county region. The death rate (age-adjusted) increased for men and women, all race/ethnicity groups, and for all age groups 15 years and older — the death rates for children under 15 did not significantly change from 2019 to 2020.

The Houston region has lower rates of premature death compared to the state and nation

Premature death measures deaths among those under age 75 per 100,000 population. Deaths at younger ages contribute more to the premature mortality rate than deaths closer to age 75.

According to the CDC, the leading causes of premature death (before the age of 65) in the United States were unintentional injuries, cancer, heart disease, cancer, and suicide. Social determinants such as poverty, lower educational attainment and social isolation contribute to premature death.¹⁸ Populations at high risk for premature death include people with obesity or diabetes, individuals who drink excessively or smoke, and those who face occupational and environmental hazards.¹⁹ Many of these premature deaths may be preventable by changing lifestyles and maintaining healthy behaviors.

Overall, the Houston region has lower rates of premature death compared to the state and national average. Fort Bend County has the lowest premature death rate in the three-county region overall and for all racial/ethnic groups. Harris County has the highest premature death rate in the three-county region overall and for most racial/ethnic groups. Premature death rates for Black residents in Harris County are double the rate for Latinos and one-and-a-half times the rate for white residents.

Heart disease and cancer cause nearly half of all deaths in the region and nation

In 2020, the top 10 leading causes of death in the U.S. were heart disease, cancer, COVID-19, accidents (unintentional injuries), stroke, chronic lower respiratory diseases, Alzheimer’s disease, diabetes, influenza and pneumonia, and kidney disease. Cumulatively, these diseases accounted for 74% of all deaths.

The top 10 leading causes of death in Texas were slightly different from the nation as a whole. While heart disease, cancer, COVID-19 and accidents were the top four leading causes of death in both the U.S. and Texas, the remaining causes of death in Texas varied slightly. Alzheimer’s, stroke, chronic lower respiratory diseases, diabetes, chronic liver disease, and kidney disease make up the remainder of the top 10 list for Texas.

What are the most significant health issues in Houston? In 2020, the top 10 leading causes of death in the Houston three-county area were heart disease (20.5%), cancer (18.0%), COVID-19 (10.4%), accidents (6.4%), stroke (4.9%), Alzheimer disease (3.7%), chronic lower respiratory diseases (2.9%), diabetes (2.9%), blood infections (1.9%), kidney diseases (1.9%), and suicide (1.9%). There are slight differences by county.

Suicide is among the top 10 leading causes of death in the Houston three-county region. In 2020, 3.1% of deaths in Harris County were the result of suicide — double what we see at the state and national levels.

Helpful Articles by Understanding Houston:

• Examining the Effects of Environmental Inequity in Houston
• Exploring the Legacy of Redlining in Houston
• The 21-Year Gap
• Children’s Mental Health in the Context of the COVID-19 Pandemic
• A Deep Dive into Domestic Violence in Texas and Houston